Dr. Allam on stent usage after upper ureteral and kidney stone treatment

In this video, Christopher Allam, MD, discusses the take-home messages from the recent Journal of Endourology study, “The Role of Routine Ureteral Stenting Following Uncomplicated Ureteroscopic Treatment for Upper Ureteral and Renal Stones: A Randomized Control Trial.” Allam is program director of the SAUSHEC Urology Residency, urology consultant to the Air Force Surgeon General, Director of Air Force Endourology, Laparoscopic, and Robotic Surgery, and an assistant professor of surgery at Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Transcription:

Based on these findings, do you plan to change anything about your clinical practice?

I have. I definitely try not to stent unless I feel it's absolutely necessary. There are some situations where I do place stents, but I am really trying to limit [my] amount of stent usage. It's nice to have a little bit of evidence behind me. There's more research that needs to be done in this area, but it's nice to have some data saying that patients probably will do better symptom wise and their complication rate should be similar. Anecdotally, I have not seen any differences when I don't leave stents compared to when I do leave stents.

What is the take-home message for the practicing urologist?

I think the take-home message is that when we are in the upper ureter and in the kidney treating stones using ureteroscopy techniques, that we don't necessarily always have to put up a stent. I think the reflex by a lot of urologists, and even me early in my practice, was I did ureteroscopy, I'm going to leave a stent, the patient will take out the stent, and we'll go from there. Other studies have shown and now this study shows in the proximal ureter and kidney that we don't necessarily have to do it. Patients probably are going to be symptomatically better without stents, and they seem to do just as well as if we place stents.

Is there anything you would like to add?

The one thing I want to mention is that this was a small sample size. It wasn't a randomized controlled trial; it did have a proven questionnaire. So I think this small sample size did show that there is definitely benefit to not leaving stents; it's safe to do. But obviously larger, randomized, controlled, multi-institutional studies need to be done. But hopefully this study at least shows the average urologist that we don't always have to reflexively place a stent just because we did ureteroscopy.

This transcription was edited for clarity.